Assessment of Autistic Spectrum Disorder

The Psychologist’s Place in the Continuum

Munira Haidermota \ Mark Sinclair

ASD is……..

Autism is now thought to be a spectrum of neurodevelopmental conditions, characterized by:

1. Difficulties in the development of social relationships.

2. Communication difficulties.

3. Repetitive behavior or strong narrow interests.

Munira Haidermota \ Mark Sinclair

Diagnostic Criteria

DSM-IV. Autistic Disorder Social – qualitative impairment in social interaction

(e.g., failure to develop peer relationships; impairment in the use of multiple non-verbal behaviours).

Language and Communication – qualitative impairments in communication (e.g. delay in the development of spoken language; stereotyped and repetitive use of language)

Thought and Behaviour – restricted repetitive and stereotyped patterns of behaviour, interests and activities (e.g., inflexible adherence to specific, non-functional routines or rituals).

Diagnostic Criteria Cont

Delays or abnormal functioning in at least one area with onset before 3 yrs; social interaction; language as used in social communication; symbolic or imaginative play.

Asperger’s Disorder Must endorse two parts of the autism triad sections 1

and 3. Plus: no clinically significant delay in language or cognitive development.

Munira Haidermota \ Mark Sinclair

Munira Haidermota \ Mark Sinclair

Diagnostic Criteria

Diagnostic criteria for ASD continue to develop.

Popularity of and the wider usage of diagnostic terms in the media and community may be little related to classification systems.

Munira Haidermota \ Mark Sinclair

Additional Diagnostic Schemes

Dissatisfaction with DSM-IV has led to the development of other systems.

Gilbergs criteria for Aspergers; 9 key points. Baron-Cohen; reworked DSM IV criteria to adapt to

higher functioning adult presentations (AAA). E.g., sections on qual impairments verbal/non-verbal communication and in imagination.

DSM-V. Aspergers will be gone; both conditions to be subsumed under ASD, and individuals differentiated on the basis of severity.

Munira Haidermota \ Mark Sinclair

NZ Guidelines

ASD in NZ is a disability, not a mental health problem. CAMHS, CMHCs deal with comorbid disorders.

Emphasis on MDT (suggestion of specialist teams within adult mental health services).

And on the use of “valid” instruments (? “Gold standard” issue).

Development of formal pathways for diagnosis (developmental services coordinators in place).

Assessment of cognitive and adaptive skills should be considered and formally assessed if appropriate.

Munira Haidermota \ Mark Sinclair

Services

Pediatric Services - child development services -most classic autism is identified in child health and before school age.

CAMHs frequently do ASD diagnoses, sometimes as a formal process.

Adult Mental Health Services may be required to make formal diagnoses.

Munira Haidermota \ Mark Sinclair

Assessment

Comprehensive Assessment Model Assess multiple areas of functioning Collect information from a variety of settings Provide a single coherent view Provide implications for adaptation and

learning Liaison with schools and other agencies to

support implementation of recommendations.

Munira Haidermota \ Mark Sinclair

Multidisciplinary Assessment

Diagnostic Assessment Developmental History Cognitive / Behavioral Neuropsychological, Academic and Vocational Speech, Language and Communication Sensory and Motor Skills Assessments Specialized Medical Evaluations

Cognitive Assessment

Behaviourally defined disorder, no biological markers.

Screening and diagnosis : behavioural observation within conceptual frameworks.

Cognitive assessments : supplement behavioural scales and developmental

checklists

Munira Haidermota \ Mark Sinclair

The Role of Cognitive Assessments

Individuals with autism demonstrate a typical pattern of performance deficits on intelligence tests.

Provide standardized information about the overall cognitive functioning of a child.

Presence of specific deficits, or in rare cases, the presence of superior splinter skills, which may go undetected during behavioral observation.

Selection and interpretation of cognitive measure will depend on a no of factors.

Common Test Batteries Non Verbal Test Batteries

Munira Haidermota \ Mark Sinclair

Instruments

Asperger Syndrome Diagnostic interview (ASDI) Asperger Syndrome Screening Questionnaire (ASSQ) Australian Scale for Asperger syndrome (ASAS) Autism Behaviour Checklist (ABC) Autism Diagnostic Observation Schedule (ADOS) and

ADOS-G Autism Screening Questionnaire (ASQ) Autism Spectrum Quotient (AQ) Autistic Diagnostic Interview (ADI, and also ADI-R) Childhood Asperger Syndrome Test (CAST) Childhood Autism Rating Scale (CARS)

Munira Haidermota \ Mark Sinclair

Instruments (contd)

Child Communication Checklist (CCC) Checklist for Autism in Toddlers (CHAT) Diagnostic Interview for Social Communication Disorders

(DISCO) Gilliam Autism Rating Scale (GARS) Parent Interview for Autism Pervasive Developmental Disorders – mental retardation

(PDD-MR) Social Response Scale (SRS) STAT TEACCH checklist Wing Autistic Disorder Interview Checklist

Munira Haidermota \ Mark Sinclair

Things To Consider

What population has the tool been validated on? Is the tool applicable to a New Zealand setting? Can the tool

be used without modification with Māori, Pacific and Asian individuals?

How long does it take to administer the tool? How many professionals are needed to administer the tool? What is needed to make the tool available in New Zealand?

Training? Qualifications required? Where can training be accessed? What is the cost of training? Ongoing costs – royalties?

Munira Haidermota \ Mark Sinclair

Challenges for Psychologists

What evidence is there that the tool leads to earlier or more accurate diagnosis?

What is realistic for Clinical and Educational Psychologists with their service and time constraints?

When should you refer to a specialist? What will a SPECIALIST do?

Munira Haidermota \ Mark Sinclair

Specialist Assessment

ASD Specific Diagnostic History1. Autism Diagnostic Interview – revised (ADI-R).2. Diagnostic Interview for Social and Communication Disorders

(DISCO)3. Developmental, Dimensional and Diagnostic Interview (3di) ASD Specific Clinical Observations and Assessment 1. Childhood Autism Rating Scale (CARS) 2. Autism Diagnostic Observation Schedule–Generic (ADOS-G) Individual Profiling1. Neuropsychological, adaptive, cognitive functioning Biomedical Investigations Comorbid Conditions

Munira Haidermota \ Mark Sinclair

Challenges

Issues confronting Adult Services Differential diagnosis. Formal diagnoses. Emphasis on developmental history in the diagnoses and absence of good information about early developmentVeneer of social competence in some individuals.Where does management fall under Getting a referral accepted by NASC services.

Child ServicesEarly AgeComplex Presentations (attentional difficulties, behavioral rigidities and emotional dysregulation). Common use of diagnostic labels complicates assessment process.Comorbid Mental DisorderAnxiety

Presenters

Clinical Psychologists: Mark Sinclair Munira Haidermota

WHIRINAKI

Child and Adolescent Mental Health Service

Counties Manukau District Health Board